PHYSICIAN FOCUS: Heads up on concussion

Tuesday

Jun 27, 2017 at 10:42 AM

Dr. Theodore Macnow, Daily News Correspondent

“Should I be worried about a concussion?” As a pediatric emergency physician, I hear this question frequently. Maybe your child fell on the playground, knocked her head, garbled her words for a few minutes, and now seems OK. But is she?

In recent years, physicians and scientists have learned a lot about concussions: what causes them, how they affect us, and how to treat them. Because of this new information, our approach to treating a concussion has changed. Here’s what you need to know to take care of your child if he or she has had a knock on the head.

First—what is a concussion, exactly? It’s a temporary disturbance of brain function after a head injury. Usually, people with concussion stay conscious. The concussion can show up in different ways. Your child may have a headache or dizziness. Her ears may ring, or she may be a little off balance. Maybe lights are bothering her eyes, she’s having trouble thinking clearly, or she’s moodier than usual. A concussion can be as vague as not feeling or functioning as well as she usually would.

A concussion is a type of traumatic brain injury (TBI)—but if your child had a brain scan, chances are everything would look normal. What’s happening, we think, is that some of the brain cells have been damaged. While the brain works to repair those cells, your child can have concussion symptoms. This is not rare. According to the Centers for Disease Control and Prevention, in 2013 there were 2.5 million ER visits for TBI (most are concussions).

How do you know if you have a concussion? The way we figure that out is by seeing whether your child’s symptoms persist over the next few days or longer. If your son got hit on the head, take him out of commission for a day or two. Take a break from school and sports. That seems to be the best way to heal, and that’s the treatment for a concussion. After a day or two, if he doesn’t have concussion symptoms, he can return to his usual activities.

If he does have concussion symptoms, he will need to resume his typical life more gradually. Follow up with your primary care doctor or pediatrician. The doctor will look at how he’s progressing and help you figure out what he can do when. That can mean returning to school, then adding light exercise, then moderate exercise, and working up to fully participating in sports again. Recent research suggests it’s OK to get light or moderate exercise and return to school before your child is 100 percent healed, because staying at home doing nothing may make him feel worse. Most concussions will heal in seven to 10 days. Some, however, cause symptoms that persist for weeks or even months.

Pushing through those symptoms raises the risk of more serious injury. Say your daughter fell on her head but wants to keep going as usual. First, she may prolong her symptoms. Second, she won’t function at her best; this would be a bad time for her to take the SATs. Third, she’s risking another head injury. When she has a concussion, her risk is highest for another concussion because she’s not operating at her peak ability (imagine playing sports when you’re not as quick or sharp). It can take less of an impact for her to get a second concussion while she’s still healing from the first, and she may need a longer recovery. In very rare cases, a repeat concussion before a child is completely healed can be severe or fatal.

Here’s what she can do with a concussion: sleep. Sleep will help her brain heal faster. In the old days, we asked patients not to sleep after a head injury because we weren’t sure if they had a head bleed and wanted to keep monitoring them. We now have excellent prediction rules and imaging to rule that out, so patients with concussion should rest easy.

Other questions are harder to answer, like whether screen time is OK when you have a concussion. We have no research looking at this. I’m generally OK with a patient watching movies if they’re not thinking too hard and if the light from the TV isn’t bothering their eyes. Many doctors are concerned that playing video games and texting may slow healing.

Seeing your child get hit on the head can be stressful. But don’t let that possibility stop your child from participating in sports. Sports are incredibly valuable for kids: They learn about exercise and teamwork, they stay out of trouble, and they can build lifelong activity habits. Those benefits far outweigh the risks of concussion.

Theodore Macnow, M.D., specializes in pediatric emergency medicine at UMass Memorial Medical Center, Worcester, and is an assistant professor in pediatrics at the University of Massachusetts Medical School. He graduated from the Tufts University School of Medicine. His academic interests include resident education, carbon monoxide and concussion.